Patient specific guides

ABSTRACT

A device for an orthopedic knee procedure. The device includes a drill guide having a body portion and first and second posts extending from the body portion, the first and second posts defining first and second internal through-bores, the first post having a first cross-sectional shape and the second post having a second cross-sectional shape different than the first cross-sectional shape of the first post.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent application Ser. No. 11/756,057, filed on May 31, 2007, which claims the benefit of U.S. Provisional Application No. 60/812,694, filed on Jun. 9, 2006.

This application is also a continuation-in-part of U.S. patent application Ser. No. 11/971,390, filed on Jan. 9, 2008, which is a continuation-in-part of U.S. patent application Ser. No. 11/363,548, filed on Feb. 27, 2006.

This application is also a continuation-in-part of U.S. patent application Ser. No. 12/038,849, filed on Feb. 29, 2008, which is a continuation-in-part of U.S. patent application Ser. No. 12/025,414, filed on Feb. 4, 2008, which claims the benefit of U.S. Provisional Application No. 60/953,637, filed on Aug. 2, 2007.

The disclosures of the above applications are incorporated herein by reference.

INTRODUCTION

Various custom made, patient-specific orthopedic implants and associated templates and guides are known in the art. Such implants and guides can be developed using commercially available software. Custom implant guides are used to accurately place pins, guide bone cuts, and insert implants during orthopedic procedures. The guides are made from a pre-operative plan formed from an MRI or CT scan of the patient and rely on matching a subcutaneous anatomic feature for correct positioning.

The present teachings provide drill guides and associated patient specific alignment guides.

SUMMARY

The present teachings provide a device for an orthopedic knee procedure. The device can include a drill guide having a body portion and first and second posts extending from the body portion, the first and second posts defining first and second internal through-bores, the first post having a first cross-sectional shape and the second post having a second cross-sectional shape different than the first cross-sectional shape of the first post.

In another aspect, the device of the present teachings can include a tibial drill guide having a body portion and first and second posts extending from the body portion, the first and second posts defining first and second internal through bores with circular cross-sections, the first post having a first cross-sectional shape and the second post having a second cross-sectional shape different than the first cross-sectional shape of the first post. The device can also include a patient-specific tibial alignment guide. The alignment guide can include a body with an inner anatomy-engaging surface shaped to closely conform and mate with a corresponding tibial joint surface, and a single guiding receptacle defining an inner channel sized and shaped to non-rotatably receive the second post of the tibial drill guide. When the alignment guide is mounted on the tibial joint surface and the drill guide is mounted on the alignment guide, the first post remains exposed outside the alignment guide and provides clearance for a patellar tendon. The first post is at a fixed orientation relative to the single guiding receptacle.

In a further aspect, the device of the present teachings can include a tibial drill and a patient-specific tibial alignment guide. The drill guide can include a body portion and first and second posts extending from the body portion, the first and second posts having circular cross-sections, the first and second posts defining first and second internal through bores with circular cross-sections, the first post having a longitudinal length shorter than a longitudinal length of the second post. The alignment guide can include a body with an inner anatomy-engaging surface shaped to closely conform and mate with a corresponding tibial joint surface, and first and second guiding receptacles defining first and second inner channels sized and shaped to receive the first and second posts of the tibial drill guide. The first receptacle can be shorter in length than the second receptacle, such that when the alignment guide is mounted on the tibial joint surface and the drill guide is mounted on the alignment guide, the first receptacle and the first post define a clearance gap between the tibia and the device for a patellar tendon.

The present teachings provide a method that includes providing a drill guide having a body portion and first and second posts extending from the body portion, the first and second posts defining first and second internal through bores, the first post having a first cross-sectional shape and the second post having a second cross-sectional shape different than the first cross-sectional shape. The method also includes providing a patient-specific tibial alignment guide, the alignment guide including a body with an inner surface shaped to closely conform and mate with a corresponding tibial joint surface, and a single guiding receptacle defining an inner channel. The method further includes mounting the alignment guide on the tibial joint surface, engaging the inner surface to the tibial joint surface, positioning the guiding receptacle on a medial side of the tibial joint surface, mounting the drill guide on the alignment guide, non-rotatably inserting the second post in the inner channel of the guiding receptacle, and placing the first post medially and closely to a patellar tendon without interfering with the patellar tendon.

In another aspect, the method includes providing a tibial drill guide having a body portion and first and second posts extending from the body portion, the first and second posts having circular cross-sections, the first and second posts defining first and second internal through bores, the first post having a longitudinal length shorter than a longitudinal length of the second post. The method also includes providing a patient-specific tibial alignment guide, the alignment guide including a body with an inner anatomy-engaging surface shaped to closely conform and mate with a corresponding tibial joint surface, and first and second guiding receptacles defining first and second inner channels, the first receptacle being shorter in length than the second receptacle. The method further includes mounting the alignment guide on the tibial joint surface, engaging the inner surface of the alignment guide to the tibial joint surface, positioning the medial guiding receptacle on a medial side of the tibial joint surface, mounting the drill guide on the alignment guide, inserting the first and second posts in the corresponding first and second inner channels of the guiding receptacle, and providing a clearance between a tibial tuberosity and first receptacle and first post for a patellar tendon.

Further areas of applicability of the present teachings will become apparent from the description provided hereinafter. It should be understood that the description and specific examples are intended for purposes of illustration only and are not intended to limit the scope of the present teachings.

BRIEF DESCRIPTION OF THE DRAWINGS

The present teachings will become more fully understood from the detailed description and the accompanying drawings, wherein:

FIG. 1 is a perspective view of a drill guide according to the present teachings;

FIG. 2 is another perspective view of the drill guide of FIG. 1;

FIG. 3 is another perspective view of the drill guide of FIG. 1;

FIG. 4 is a perspective view of a drill guide according to the present teachings;

FIG. 5 is another perspective view of the drill guide of FIG. 4;

FIG. 6 is a perspective view of a patient-specific alignment guide according to the present teachings;

FIG. 7 is a perspective view of the patient-specific alignment guide of FIG. 6 shown with the drill guide of FIG. 1;

FIG. 8 is a perspective view of a patient-specific alignment guide shown with a drill guide according to the present teachings;

FIG. 9 is a perspective view of a drill guide according to the present teachings;

FIG. 10 is another perspective view of the drill guide of FIG. 9;

FIG. 11 is another perspective view of the drill guide of FIG. 9;

FIG. 12 is a sectional view of the drill guide of FIG. 11 taken along line 12-12;

FIG. 13 is a side view of the drill guide of FIG. 11;

FIG. 14 is a perspective view of a patient-specific alignment guide according to the present teachings;

FIG. 15 is another perspective view of the patient-specific alignment guide of FIG. 14;

FIG. 16 is another perspective view of the patient-specific alignment guide of FIG. 14;

FIG. 17 is an environmental view of the patient-specific alignment guide of FIG. 14 shown on a tibia;

FIG. 18 is another environmental view of the patient-specific alignment guide of FIG. 14 shown on a tibia; and

FIG. 19 is an environmental view of the patient-specific alignment guide of FIG. 14 and the drill guide of FIG. 9 shown on a tibia.

DESCRIPTION OF VARIOUS ASPECTS

The following description is merely exemplary in nature and is in no way intended to limit the present teachings, applications, or uses. For example, although the present teachings are illustrated for alignment guides in knee surgery, the present teachings can be used for other guides, templates, jigs, drills, rasps or other instruments used in various orthopedic procedures.

The present teachings generally provide patient-specific alignment guides and associated drill guides for use in orthopedic surgery, such as in knee arthroplasty, for example. The patient-specific alignment guides can be used either with conventional or patient-specific implant components prepared with computer-assisted image methods. Computer modeling for obtaining three dimensional images of the patient's anatomy using MRI or CT scans of the patient's anatomy, the patient specific prosthesis components, and the patient-specific guides and templates can be provided by various CAD programs and/or software available, for example, by Materialise USA, Ann Arbor, Mich.

The patient-specific alignment guides are generally formed using computer modeling based on the patient's 3-D anatomic image and have an inner engagement surface that is made to conformingly contact and match a three-dimensional image of the patient's bone surface (with or without cartilage or other soft tissue), by the computer methods discussed above. The patient-specific alignment guides can include custom-made guiding formations, such as, for example, guiding bores or cannulated guiding posts or cannulated guiding extensions or receptacles that can be used for supporting or guiding other instruments, such as drill guides, reamers, cutters, cutting guides and cutting blocks or for inserting pins or other fasteners according to a surgeon-approved pre-operative plan. The patient-specific alignment guides can be use in minimally invasive surgery, and in particular in surgery with multiple minimally-invasive incisions. In one aspect, the drill guides can include guiding cannulated or tubular legs that can be received in the guiding bores of the alignment guides for drilling therethrough, as discussed below.

The patient-specific alignment guides and the associated drill guides can be structured to provide or define a clearance for tendons, ligaments or other tissues associated with the joint. In the exemplary illustrations of FIGS. 1-19, various alignment guides 300 and drill guides 100 are structured to have specific geometric features for avoiding a tendon associated with the tibia of the knee joint, while enabling the placement of a drill as close to the tendon as determined by the surgeon and while maintaining an alignment relative to the joint as determined by the pre-operative surgical plan. A first aspect of the present teachings is discussed in connection with FIGS. 1-8, and a second aspect in connection to FIGS. 9-18.

Referring to FIGS. 1-5, an exemplary drill guide 100 according to the present teachings includes a body portion 102, a cylindrical handle portion 104, a first or medial cannulated post 106 extending from the body portion 102 and defining an inner bore 112 for guiding a pin or a drill bit, and a second or lateral cannulated post 108 extending from the body portion 102 and defining an inner bore 110 for guiding a pin or a drill bit. The first post 106 can be a medial post relative to the second post or relative to the patient's anatomy, and the second post 108 can be a lateral post relative the patient's anatomy. The inner bores 112 and 110 can have circular or non-circular cross-sections and can be configured for receiving drill bits or pins. The first and second posts 106, 108 can have cross-sectional areas of different shapes relative to one another.

Referring to FIGS. 1-3, the second post 108 can be shaped to have an outer surface 109 having a cross-section in the form of a keyhole, i.e. a shape that includes a cylindrical portion 127 and a prismatic portion 129 extending radially from the cylindrical portion, as shown in FIG. 3, although the outer surface 109 can have other shapes that can increase the rotational stability and prevents rotation of the drill guide 100, when the drilling guide 100 is mounted on an alignment guide 300, as discussed below.

Referring to FIGS. 4 and 5, the second post 108 can have a cross section in the shape of a rectangle, for example. The second post 108 can have a cross-section with larger cross-sectional area than the cross-sectional area of the first post 106. The second post 108 can also be bigger in overall size and dimensions than the first post 106.

Referring to FIGS. 6-8, alignment guides 300 for use with the tibia are illustrated. The alignment guide 300 can include a body portion 302 having an inner anatomy-engaging surface 304, which is molded or otherwise shaped to closely conform in substantially mirror-like manner to the surface of the joint anatomy of the patient, in this particular example, the tibia with or without associated soft tissue, depending on the patient and the surgical procedure. The alignment guide 300 is placed on the lateral side of the proximal joint surface of the tibia 80, such that the inner surface 304 conforms to proximal and anterior portions of the lateral side of the tibia 80, as shown in FIGS. 17-19. The alignment guide 300 can also include an elongated arcuate arm 310 having first and second ends 309, 311, the first end 309 attached to the outer surface of the body portion 302, and the second end 311 engageable with the tibia. The arm 310 can arch and extend away from the body portion 302 and provide a handle for manipulating the alignment guide 300. The second end 311 of the arm 310 can provide a stabilizing surface engaging the tibia.

The alignment guide 300 can include one or more guiding receptacles, the precise location of which is determined on the basis of a pre-operative surgical plan for locating alignment pins and assisting in locating drilling and/or cutting instruments for resecting and shaping the joint for receiving a prosthetic implant, as described in commonly-owned, co-pending in U.S. patent application Ser. No. 11/756,057, filed on May 31, 2007, incorporated herein by reference. The alignment guides 300 illustrated in FIGS. 6-8 include a single guiding receptacle 308, while the alignment guide 300 illustrated in FIGS. 14-19 includes two guiding receptacles 306, 308.

The alignment guide 300 can include a lateral guiding receptacle 308 extending from the body portion 302 on a lateral side relative to the tibia. The guiding receptacle 308 can enclose and define an inner channel 318 having a cross-section shaped and sized to receive the corresponding lateral post 108 of the drill guide 100, as shown in FIGS. 6-8. A channel 318 having a keyhole-shaped cross-section for receiving the keyhole-shaped lateral post 108 of the drill guide 100 in a keyed or non-rotatable manner is illustrated in FIGS. 5 and 6. A channel 318 with an elongated rectangular cross-section for non-rotatably receiving the rectangularly-shaped lateral post 108 of the drill guide is illustrated in FIG. 8. As can be seen from FIGS. 7 and 8, the medial post 106 of the drill guide 100 is remains exposed outside the alignment guide 300, such that when the alignment guide 300 engages the tibia, the medial post 106 is exposed outside and not engaged with the alignment guide 300, thereby providing clearance for the patellar tendon that connects to the tibial tuberosity, which is shown at 82 in FIG. 18 in connection with a different aspect of the present teachings discussed below. Further, the unencumbered exposed medial post 106 can be placed axially as close to the patellar tendon as determined by the surgeon without being obstructed by the alignment guide 300, while maintaining a fixed orientation relative to the guiding receptacle 308 of the alignment guide 300. The location of the medial post 106 relative to the tibia is predetermined by the location of the lateral post 108, which in turn is pre-determined by the channel 318 of the alignment guide on the basis of a preoperative surgical plan.

The shape and size of the cross-sectional area of the keyhole-shaped or rectangular lateral post 108 of the drill guide 100 is keyed to lateral receptacle 308 of the alignment guide 300 fixing the location and orientation of both lateral and medial posts 108, 106 and providing rotational stability to the drill guide 100, when the lateral post 108 is received in the corresponding channel 318 of the lateral receptacle 308 of the alignment guide 300. In this respect, the shape of the lateral post 108 aligns the drill guide in a keyed manner to the alignment guide 300, providing rotational stability and providing resistance against rotation, such that the medial post 106 can be remain exposed and unsupported by the alignment guide 300 during drilling through the drill guide 100 to provide clearance for the patellar tendon while maintaining the orientation and location of the lateral and medial posts 108, 106 predetermined by the alignment guide 300 on the basis of a pre-operative plan, as discussed above.

Referring to FIGS. 9-18, a drill guide 100 having lateral and medial posts 108, 106 is illustrated in FIGS. 9-13 for use with a corresponding alignment guide 300 having corresponding lateral and medial receptacles 308, 306 with cylindrical channels 318 and 316, as shown in FIGS. 14-19.

Referring to FIGS. 9-13, both the lateral and medial posts 108, 106 of the drill guide 100 can be cylindrical with circular cross-sections, but the medial post 106 can be shorter than the lateral post 108. The medial post 106 can have a length L1 which is smaller than a length L2 of the lateral post 108. The difference in length provides a clearance for the patellar tendon, as discussed below. The medial and lateral posts 106, 108 can have cross-sections of equal or unequal size. The cross-sectional area of the lateral post 108 can also be larger than the cross-sectional area of the medial post 106.

Referring to FIGS. 16-18, the medial receptacle 306 is also shorter than the lateral receptacle 308, such that when the alignment guide 300 is mounted on the tibia 80, a clearance gap 90 can be formed between the tibial tuberosity 82 and a free end 320 of the medial receptacle 306. The shorter length of the medial receptacle 306 of the alignment guide 300 corresponds to the shorter length of the medial post 106 of the drill guide 100, such that the clearance gap 90 can be maintained when the drill guide 100 is mounted on the alignment guide 300 for drilling, as shown in FIG. 19. The gap 90 provides a clearance for the patellar tendon, while the medial and lateral receptacles 306, 308 of the alignment guide 300 stabilize the drill guide 100. Further, the medial receptacle 306 and medial post 106 can be placed as close to the patellar tendon as determined by the surgeon without obstruction from the alignment guide 300 or the drill guide 100, such that a drill pin can be passed through the medial post 106 without interfering with the patellar tendon for drilling a hole on the tibial surface associated with the knee joint, or tibial joint surface for brevity. Drill pins can be used to support cutting guides or other instruments for making reactions as discussed in detail in U.S. patent application Ser. No. 11/756,057, filed on May 31, 2007, the disclosures of which are incorporated herein by reference.

It will be appreciated from the above discussion that the present teachings provide alignment guides and drill guides that can be used together to provide tendon or other soft tissue clearance, while providing stability during drilling through the alignment guide.

The foregoing discussion discloses and describes merely exemplary arrangements of the present teachings. Furthermore, the mixing and matching of features, elements and/or functions between various embodiments is expressly contemplated herein, so that one of ordinary skill in the art would appreciate from this disclosure that features, elements and/or functions of one embodiment may be incorporated into another embodiment as appropriate, unless described otherwise above. Moreover, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope thereof. One skilled in the art will readily recognize from such discussion, and from the accompanying drawings and claims, that various changes, modifications and variations can be made therein without departing from the spirit and scope of the present teachings as defined in the following claims. 

What is claimed is:
 1. A device for an orthopedic knee procedure for a specific patient comprising: a tibial drill guide having a body portion and first and second elongated posts extending away from and outside the body portion, the first and second posts defining corresponding first and second internal through bores with circular cross-sections for guiding a drill, the first post having a first circular cross-sectional shape and the second post having a second cross-sectional shape, the second post having an outer surface including an elongated cylindrical portion with a circular cross-section and an elongated prismatic portion with a rectangular cross-section extending radially from and attached to the cylindrical portion and forming a keyhole shape with the cylindrical portion, the second internal through bore passing through the elongated cylindrical portion of the second post; and a patient-specific alignment guide, the alignment guide including: a body with an inner anatomy-engaging surface shaped to conform and mate as a mirror surface of a corresponding knee joint surface of the patient; and a single guiding receptacle defining an inner channel sized and shaped to non-rotatably receive the second post of the drill guide, the inner channel having a cross-section with a circular portion and a rectangular portion communicating with the circular portion, wherein, when the alignment guide is mounted on the joint surface and the second post of the drill guide is received in the single guiding receptacle of the alignment guide, an exterior sidewall of the first post of the drill guide remains exposed and out of contact with the alignment guide and provides clearance for a tendon associated with the joint surface.
 2. The device of claim 1, wherein the alignment guide is configured according to a pre-operative surgical plan and the inner surface mirrors an anterior portion and a proximal portion of a tibial surface of the patient from imaging scans specific to the patient.
 3. A device for an orthopedic knee procedure for a specific patient comprising: a tibial drill guide having a body portion and first and second posts extending from the body portion, the first and second posts defining corresponding first and second internal through bores with circular cross-sections for guiding a drill, the first post having a circular cross-section and the second post having a non-circular cross-section; and a patient-specific tibial alignment guide, the alignment guide including: a body with an inner anatomy-engaging surface shaped from imaging scans of a knee joint of the specific patient to conform and mate as a mirror surface of an anterior portion and a proximal portion of a tibial joint surface of the patient; and a single guiding receptacle defining an inner channel having a non-circular cross-section sized and shaped to non-rotatably receive the second post of the tibial drill guide, wherein when the alignment guide is mounted on the tibial joint surface and the drill guide is connected to the alignment guide, the first post remains exposed outside the alignment guide and provides clearance for a patellar tendon, the first post at a fixed orientation relative to the single guiding receptacle of the alignment guide.
 4. The device of claim 3, wherein the second post of the tibial drill guide extends away and outside the body portion and has an outer surface with a cylindrical portion with a circular cross-section and a prismatic portion with rectangular cross-section extending from the cylindrical portion and wherein the inner channel of the guiding receptacle of the tibial alignment guide has a cross-section with a circular portion and a rectangular portion.
 5. The device of claim 3, wherein the second post of the drill guide extends away and outside the body portion and has a substantially rectangular cross-section and wherein the inner channel of the tibial alignment guide has a substantially rectangular cross-section.
 6. The device of claim 4, wherein the rectangular portion of the inner channel extends radially from the circular portion.
 7. The device of claim 3, wherein the alignment guide includes an arcuate arm having a distal end engageable with the tibia.
 8. An orthopedic method comprising: mounting a tibial alignment guide on a tibial joint surface of a specific patient, the alignment guide including a body with a patient-specific inner surface shaped from imaging scans of the knee joint of the specific patient to conform and mate as a mirror surface of a proximal portion and an anterior portion of the tibial joint surface of the specific patient, and a single guiding receptacle defining an inner channel having a non-circular cross-section; engaging the inner surface to the proximal and anterior portions of the tibial joint surface with the guiding receptacle on the anterior portion of the tibial joint surface; mounting a drill guide on the alignment guide, the drill guide having a body portion and first and second posts extending from the body portion, the first and second posts defining first and second internal through bores with circular cross-sections, the first post having a first circular cross-sectional shape and the second post having a second non-circular cross-sectional shape configured to mate with the non-circular cross-sectional shape of the inner channel of the alignment guide; non-rotatably inserting the second post of the drill guide into the inner channel of the guiding receptacle of the alignment guide; and placing the first post outside the alignment guide without interfering with a patellar tendon of the patient.
 9. The method of claim 8, wherein the inner channel of the guiding receptacle includes a cylindrical portion having a circular cross-section and a prismatic portion having a rectangular cross-section extending from the cylindrical portion and wherein the second post of the drill guide includes an outer surface having a cylindrical portion with a circular cross-section and a prismatic portion with a rectangular cross-section extending from the cylindrical portion and wherein the second internal through bore passes through the cylindrical portion.
 10. The method of claim 8, wherein the inner channel of the guiding receptacle of the alignment guide includes a rectangular cross-section.
 11. The method of claim 10, wherein the second post of the drill guide includes an outer surface having a rectangular cross-section configured to be received into and mate with the rectangular-cross-section of the inner channel. 